Work package 13: Clinical Decision Support

Brief description and aims of work

A decision tool is an active knowledge resource that uses patient data to generate case-specific advice which supports decision making about individual patients by health professionals, the patients themselves or others concerned about them. Decision tools’ characteristics:

• The target decision maker: the tool is designed to aid a health professional and/or a patient in a clinical decision making.
  
• The target decision: the decisions concerned to an individual patient.
  
• The knowledge component: the tool uses patient data and knowledge to generate an interpretation that aids clinical decision making.
  
• Timing: the tool is used before the health professional or a patient takes the relevant decision.
  

This WP starts with the elaboration of the CDS use scenarios that we aim to support, based on the clinical scenarios developed in WP2. It is of utmost importance that the selected user scenarios have to drive the technology development and not vice versa. This gives an indication of what type of information is needed to manage, what decision support services we aim to build, etc. On top of that, of course we need to look at ways to extract and combine the relevant information and to make it targeted to a specific patient.

The main objective of WP13 is to develop tools able to support the clinicians to efficiently access all relevant data and infer knowledge necessary to reach the most accurate diagnosis and prescribe the most suitable treatment. By making use of the latest medical evidence, our CDS solutions will support clinicians to provide personalized treatment and improve patient outcomes. Proper implementation and use of clinical decision support systems is regarded as an important recommendation for reducing the frequency and consequences of errors in medical care .

A second objective of this WP is to support the clinicians to prevent or identify early in the treatment potentially serious side effects to treatments and drugs, and the patients most susceptible to develop serious side effects. The project moves between technological expertise and clinical competences. In fact, CDS serves physicians’ needs to improve decision efficacy through the use of electronic systems. However, we propose to create a link between this two areas starting from the above considerations. Cognitive psychology, actually, may contribute to give rise to more practical and effective decision tools, and improve human actors’ (physicians, technicians, nurses and so on) trust in these systems. This goal can be obtained through the following steps:

• Using the actual cognitive theories of decision-making processes will accomplish a schematic architecture of an ideal decision support tool. This architecture will be adapted to the clinical context and tested for face and construct validity thanks to a panel of experts, privileged testimonials, and a beta testing phase. The conceptual structure will use tree graphs representations.
  
• Implementation of the tool in electronic format (off-line). Once implemented the feasibility of the instrument will be tested by a sample of physicians belonging to different specializations and IT tools experiences.
  
• Testing the tool in a restricted sample for efficacy and user satisfaction.
  
• An extensive survey about physician attitudes toward CDS will be performed in order to understand the actual context. Trust concerns will be particularly handled. This step will be useful to investigate and appreciate physician’ needs, fears and practical difficulties when approaching CDS.
  

In order, to improve physicians’ trust in technological decision aids and to support an effective use of CDS, an ad-hoc education program will be tested within a small group of physicians. This test will give rise to a potential standard of decision-makers education in health. The scope of the program will be sufficiently wide to include both cognitive and psycho-social issues. In fact, to achieve the important goal to improve decision efficacy through the use electronic aid, physicians will have to understand better cognitive as well as affective and relational decision-related concerns.

Work package leader

•  WP 12
• WP 14